<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209080
Report Date: 09/24/2024
Date Signed: 09/25/2024 06:04:19 AM


Document Has Been Signed on 09/25/2024 06:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:VICTORIA'S CARE HOMEFACILITY NUMBER:
107209080
ADMINISTRATOR:GITTI, JOSEPHFACILITY TYPE:
740
ADDRESS:5288 N. ROSALIA AVETELEPHONE:
(559) 960-3789
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY:6CENSUS: 4DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Joseph Gitti, Administrator TIME COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/24/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required annual inspection. LPA was greeted by caregiver, stated the purpose of the visit and was allowed entry into the facility. Caregiver contacted the Administrator, who arrived to the facility shortly after.

LPA toured the facility inside and out. LPA observed 4 residents in care at the time of visit. Residents in care receive Regional Center services. Facility is a 4 bedroom 2 bathroom home. Bathrooms were observed to have grab bars, Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 111 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the entry. Cleaning supplies were observed to be locked in the garage. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored.

Carbon monoxide and smoke detectors were tested and observed to be operational. Night lights were observed in the hallways. Fire Extinguisher was observed with a service date of 01/04/24. First aid kit was observed and contained all required items. Internet devices and a working phone line were observed to be available for residents in care. Required postings were observed.

No residents are receiving Hospice services residents or receiving Home Health care service. A sample of resident and staff files were reviewed and observed to have the required forms and training records. No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1